Reactive Airway Disease

Last updated: April 8, 2026, 2:53 PM Pacific Time (PDT)
Shared bedside framework for obstructive airway disease, mainly asthma, COPD, and overlap phenotypes. Use it to organize baseline severity, confirm obstruction, identify triggers, and tailor exacerbation treatment.
All Clinical risk factors Diagnostics Confirmation criteria Management Back to Main Page

Disease Pathway

risk factors -> diagnostics -> diagnostic pattern -> phenotype-based management
Clinical Risk Factors

Who should trigger obstructive-airway reasoning?

  • Wheeze, chest tightness, dyspnea, cough, prolonged expiratory phase, or increased work of breathing
  • Known asthma, COPD, smoking history, prior intubation, prior ICU stay, or repeated steroid bursts
  • Trigger story: viral URI, allergen exposure, aspiration, air pollution, medication nonadherence, beta-blocker exposure
  • Hypercapnia risk clues: somnolence, asterixis, worsening tachypnea, accessory-muscle fatigue, or chronic home oxygen
  • Alternative-life-threat clues: stridor, unilateral breath sounds, chest pain, hemoptysis, fever, shock, or new edema
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Diagnostics

Confirm obstruction and tailor the workup to the care setting

Core labs
  • VBG / ABG
  • CBC
  • BMP
  • Magnesium
Additional labs
  • Respiratory viral panel
  • Sputum culture
  • BNP
  • Troponin
  • D-dimer
Imaging / diagnostics
  • CXR
  • ECG
  • Peak flow
  • POCUS
  • CT chest
Monitoring
  • Continuous pulse ox
  • Repeat VBG / ABG
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Differential Diagnosis

Keep common mimics and parallel processes in play

Inpatient / ED
  • CHF / flash edema, pneumonia, PE, pneumothorax, aspiration, mucus plugging
  • Upper-airway edema, vocal cord dysfunction, anaphylaxis
  • ACS or arrhythmia driving dyspnea rather than airway obstruction
Outpatient
  • Deconditioning, CHF, vocal cord dysfunction, obesity hypoventilation, GERD, chronic rhinitis/post-nasal drip
  • Interstitial lung disease or pulmonary vascular disease if symptoms do not fit obstruction
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Confirm Diagnosis

Use phenotype plus objective pattern

  • Asthma-predominant: variable symptoms, trigger pattern, bronchodilator responsiveness, atopy, or eosinophilic features.
  • COPD-predominant: persistent airflow obstruction with smoking or inhalational exposure history, chronic sputum, emphysema/chronic bronchitis features, or home oxygen history.
  • Overlap / RAD framing: bedside syndrome with obstructive symptoms where immediate management is similar even before formal outpatient spirometry labels the phenotype.
  • Severe exacerbation clues: worsening hypercapnia, hypoxemia, exhaustion, inability to speak, silent chest, or altered mental status.
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Management

Frame recommendations as maintenance therapy plus flare treatment

Working phenotype

Resident Pearls

Bedside Use

  • Treat the flare while you keep alternate causes of dyspnea running in parallel.
  • A quiet chest plus fatigue is more concerning than loud wheeze.
  • For COPD-predominant exacerbation, avoid over-oxygenation and titrate to a reasonable saturation target if chronic CO2 retention is likely.
  • Use steroids early when you think this is true obstructive-airway inflammation, but do not let steroids delay NIV, ICU evaluation, or alternate diagnoses.
  • Once stable, the chronic question is phenotype and inhaler plan; the acute question is whether the patient is tiring out.

Sources